Do low preoperative vitamin D levels reduce the accuracy of quick parathyroid hormone in predicting postthyroidectomy hypocalcemia?

BACKGROUND: Although some studies have suggested that low preoperative 25-hydroxyvitamin D (25-OHD) levels may increase the risk of hypocalcemia and decrease the accuracy of single quick parathyroid hormone in predicting hypocalcemia after total thyroidectomy, the literature remains scarce and inconsistent. Our study aimed to address these issues. METHODS: Of the 281 consecutive patients who underwent a total/completion total thyroidectomy, 244 (86.8 %) did not require any oral calcium and/or calcitriol supplements (group 1), while 37 (13.2 %) did (group 2) at hospital discharge. 25-OHD level was checked 1 day before surgery, and postoperative quick parathyroid hormone (PTH) was checked at skin closure (PTH-SC). Postoperative serum calcium was checked regularly. Hypocalcemia was defined by the presence of symptoms or adjusted calcium of /=15 ng/mL via bootstrapping. RESULTS: Preoperative 25-OHD level was not significantly different between groups 1 and 2 (13.1 vs. 12.5 ng/mL, p = 0.175). After adjusting for other significant factors, PTH-SC (odds ratio 2.49, 95 % confidence interval 1.52-4.07, p /=15 ng/mL (0.880 vs. 0.850, p = 0.61) CONCLUSIONS: Low 25-OHD was not a significant factor for hypocalcemia and did not lower the accuracy of quick PTH in predicting postthyroidectomy hypocalcemia.published_or_final_versio

Inhaled foreign bodies: children with peanut in airway

Foreign body aspiration is a common problem in young children. Many patients present after a significant delay despite having a witnessed choking event. Moreover, their presentations may mimic other common respiratory problems like pneumonia or asthma. It is extremely important to be attentive to history taking and clinical signs that may indicate early bronchoscopy to confirm the diagnosis.published_or_final_versio

A prospective study of a one-week non- bismuth quadruple therapy for childhood Helicobacter pylori infection

Purpose: In The Eradication Of Helicobacter Pylori Infection, A 1-Week Therapy Improves Patient Compliance, But Drug Resistance May Limit Its Efficacy. The Effectiveness Of The 1-Week Nonbismouth Quadruple Therapy Was Studied Prospectively In Children With Proven H Pylori Infection In A Population With A High Rate Of Metronidazole Resistance. Methods:All Pediatric Patients Who Presented To Our Institutions With Acute And Chronic Upper Gastrointestinal Conditions Requiring Endoscopy From June 1997 To February 2000 Were Investigated Prospectively For H Pylori Infection. Gastric Biopsy Specimens Were Analyzed With Rapid Urease Test And Histopathology, H Pylori-Positive Children Were Treated With Omeprazole, Clarithromycin, Amoxicillin, And Metronidazole For 7 Days. The Result Of Treatment Was Assessed 1 Month After Treatment With Endoscopy And Biopsy. The Same Treatment Was Repeated For 2 Weeks If H Pylori Was Still Present. In Patients Who Needed A Third Endoscopy, Their Biopsy Specimens Were Cultured To Determine Antibiotic Sensitivity. Results Were Correlated With Patients' Symptoms And Endoscopic Findings. Results: Thirty-Three Children With Acute (Severe Epigastric Pain, N = 14; Gastrointestinal Bleeding, N = 9) And Chronic (Recurrent Abdominal Pain, N = 7; Anemia, N = 3) Conditions Were Treated For H Pylori. Thirty-One (94%) Were Confirmed To Have H Pylori Eradicated By A 1-Week Therapy, Whereas 1 Patient Had Eradication After A Further 2-Week Therapy (3.3%). The Only Unresponsive Patient Had H Pylori Resistant To Both Clarithromycin And Metronidazole. All Ulcers And Erosions Healed After The Eradication Of H Pylori. Three Patients Had Persistent Recurrent Abdominal Pain Despite H Pylori Eradication. Conclusions: The 1-Week Therapy With Omeprazole, Clarithromycin, Amoxicillin, And Metronidazole Is An Effective Treatment Of Hpylori In Children In A Population With A High Incidence Of Metronidazole Resistant Strain Of H Pylori. Peptic Ulcers And Erosions Healed With The Eradication Of The Bacteria. Copyright © 2001 W.B. Saunders Company.link_to_subscribed_fulltex

Chronic cough in children: A retrospective review

Cough is a common complaint in children. However, data on aetiologies and outcome of chronic cough are sparse in Hong Kong Chinese children. Methods: Records of children referred to the out-patient clinic for chronic cough, defined as cough for more than 4 weeks, in Kwong Wah Hospital, a secondary hospital, over a 12-month period were reviewed. Underlying diagnoses and outcomes after follow up for a variable period were ascertained. Results: 42 patients were included. Chronic cough cases represented 8% of the new referrals. The most common final diagnosis was allergic rhinitis (31%), followed by asthma. Over a follow up period ranging from 4 to 12 months, cough resolved in 54.8%, partially resolved in 40.5% and persisted in 4.7% of patients. Persistent nasal symptoms were identified in 54.8% of our chronic cough patient. 43.5% of allergic rhinitis patient had co-existing asthma. Conclusion: Allergic rhinitis with or without co-existing asthma is the commonest cause of chronic cough in children referred to this department

Indocyanine Green (ICG) Fluorescence assessment of conduit vascularity for minimally invasive esophagectomy

Daily Program, Oral Paper 7: Translational Research: abstract no. OP7-0

Lymphadenectomy with continuous vagus nerve stimulation for recurrent laryngeal nerve monitoring in thoracoscopic esophagectomy

Abstract (VS01: Video Session 1: Malignant 1)Background: Lymphadenectomy by videothoracoscopic (VATS) approach for esophageal cancer is technically challenging. Extended lymphadenectomy may increase the chance of recurrent laryngeal nerve (RLN) injury. Continuous Intraoperative RLN monitoring (CIONM) may help reduce the incidence of nerve injury. We present a video illustrating the use of a system of continuous intraoperative vagus nerve stimulation to monitor RLN function during VATS esophagectomy. Methods: The patient is placed in the supine position first. The left vagus nerve is exposed between the carotid artery and internal jugular vein via a left cervical approach. A stimulation probe is anchored to the nerve. Continuous vagus nerve stimulation is applied and the functional integrity of the left RLN is monitored by a sensor that is integral with the endotracheal tube. The patient is then placed in the left lateral position for VATS esophagectomy. One lung anaesthesia is achieved by a right bronchial blocker. A 5cm minithoracotomy and 4 other port sites are created. In right RLN nodal dissection, we utilize intermittent stimulation of the right RLN for nerve mapping and testing its integrity, but for the left RLN, CIONM was used since the chance of damaging the left RLN is much higher. Stimulation frequency was set at once per second while left RLN lymphadenectomy is performed. After the VATS phase, the patient is placed again in the supine position for laparoscopic gastric mobilization and the gastric conduit is delivered to the neck for cervical esophagogastrostomy. Nerve monitoring is terminated after completion of the anastomosis. Results: The patient recovers from his surgery without complication. Discussion: CIONM with vagus nerve stimulation is a useful adjunct to RLN lymphadenectomy for esophageal cancer

Modern results of esophagectomy for esophageal cancer: impacts of multimodality treatment and minimally invasive approach

Poster PresentationLink_to_subscribed_fulltex

Pulmonary sequestration in an infant

Pulmonary sequestration is a congenital anomaly of lung parenchyma without a normal connection to the tracheobronchial tree and an anomalous systemic arterial supply. We report an 11-month-old boy with extralobar pulmonary sequestration. Magnetic resonance angiogram identified the arterial supply from aorta and venous drainage to azygous vein. Various imaging techniques for diagnosis of pulmonary sequestration are discussed.link_to_OA_fulltex